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HomeMy WebLinkAboutRBPR-04-2016-23619.TIF �gA �G THIS IS NOT A PERMIT Case # RBPR-04-2016-23619 CATAWBA COUNTY HEALTH DEPARTMENT o . , 'vo 0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES /842 sM Residential Building Plan Review - Building New .0. _ .n .o IMPROVEMENT - AUTH_CONST • 1:1 l Applicant BRANDON PROKUPEK, 554 TROUTMAN FARM RD, STATESVILLE NC 28677 C:7048832253 Contractor LAKE LUXURY HOMES, LLC (RAY SHORT), PO BOX 3792, MOORESVILLE NC 28117 H:8282411234 C:7045162344 HOME:8282411234F:8282411206 VRSHORTJR @AOL.COM Owner BRANDON PROKUPEK, 554 TROUTMAN FARM RD, STATESVILLE NC 28677 C:7048832253 NAME TO APPEAR ON PERMIT Lake Luxury Homes, LLC (Ray Short) SITE ADDRESS: 3730 BUNKER HILL SCHOOL RD, CLAREMONT NC 28610 PIN # 376207794221 NAME of SUBDIVISION: Lot/ Section/Block PROPERTY SIZE: Square Feet Acres 10 DIRECTIONS: I-40E/left Bunker Hill School Rd PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: new single family dwelling 60 x 60 "will get well easement from neighbor to tie into existing well. SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? No Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF vacant lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 60 x 60 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: PO-ehappl ication 04/11/2016 14:40 Page 1 of 4 CATAWBA COUNTY Case/I RBPR-04-2016-23619 my Public Health Department Subdivision 7 Environmental Health Division PIN# 376207794221 "-�- PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 1g42 ,u NAME ON PERMIT: LAKE LUXURY HOMES, LLC ( RAY SHORT), PO BOX 3792, MOORESVILLE NC 28117 Lake Luxury Homes, LLC ( Ray Short) Site Address: 3730 BUNKER HILL SCHOOL RD, CLAREMONT NC 28610 Property Size: Square Feet Acres 10 Directions: 1-40E/left Bunker Hill School Rd Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 t Ft rFii,i E NgyA!M .. pi r i.,_ 7 90 7 ii _b .., f ier - . R A 1 SFEErAMOUNT;EJ,� ,askr !11 .p,,Li Authorization to Construct Fee (New/Expansion) 04/08/2016 $150.00 Fee Improvement Permit Fee 04/08/2016 $150.00 r r 4 d rTOTAL FEE t v. 1 ' W r � `t a $300 05 `4P∎ x311 rc .4t r $ 0 rs 2 t ''.... :`rz..iL_.i3 :.:I+r..•...aT1....r':ufr...,L., 4,3 r3 qsn„u.... a`ititia b`t.JW,t....d„�...aA.�l FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehappli cation 04/11/2016 14:40 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT COUNTY - CATAWBA COUNTY HEALTH DEPARTMENT "-. . F Application for Environmental Services Page 1 Improvement Permit* Authorization to Construe Septic Repair n Septic Malfunction n Septic Expansion n New Well Permit❑ Replacement Well ❑ Well Abandonment n Well Repair n Existing System Inspection (Pre-Approval Required) ❑ (� Application is for New Construction Existing Facility ❑ Property Address 80 AA/ , lb tisk bdivision Lot# Acres in U 7 / coon/BI hale ,`` ' Driving Directions to Property 6 0 F 1 L-Q 0 2.-LA, r 'LPL/ • t S eot NAME TO APPEAR ON PERMIT? n Owner n Applicant LXontractor Applicant Contact Information Address /VP /fl/C ,4 zn Al (/c 7C A/.- 2696 27 Phone ///�0/�, g" . 3 - � ZS3 Cell Phone * Owner Co ntact Information Name • 4 OA) it-to Le A. 4 --e /CH Address illararte ILL Lal —4- daralar -47C> -&Z7 Phone ✓ % F 3 —72,53 Ce l Phone Contractor Contact Information �r � Name 1.44_1_e u ,t.., l Ate./..-zt// License# ' (, 67 7 • Address P Q t ox 3 2 .2– Phone /P 62 �j� /t/C 2y//7 Cell Phone WHO WILL BE THE PRIMARY CONTACT? In Owner ❑ Applicant KContractor Description of Existing Structures on Site V i 11 Cot # of Bedrooms *t Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property 'n question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes 4 4o Does the site contain any jurisdictional wetlands? ❑ Yes ri o Does the site contain any existing wastewater systems? kYes • ..e Is any wastewater going to be generated on the site other than domestic sewage? res �X; ...,,,������"""to Is the site subject to approval by any other public agency? El Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use Individual Well Community Well I I Semi-Public Well ❑ County/City/Township Water Line ' is a public water supply available? ** n Yes ' No If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other ' Any CATAWBA THIS IS NOT A PERMIT • ,...COUNTY ,.,- CATAWBA COUNTY HEALTH DEPARTMENT „„„„ ,707,na Application for Environmental Services Page 2 Proposed Facility Type c� ❑ Primary Residence Np`y ResAnce n Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions 0 X (o p #of Occupants Basement n Yes Slft7No Basement Fixtures ❑ Yes,No ❑ Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes n No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*t Total #Bedrooms *t Structure Dimensions El Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts Other Facility Type Specify If Church#of Seats Kitchen Ti Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type I I Individual Well n Semi-Public Well n Community Well Abandonment Type ❑ Drilled 17 Bored n Dug n Unknown Well Repair Requested n Yes n No Describe Calculated Design Flow, Commercial t Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on-site staff. *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications. The number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. j If structure is plumbed but no bedrooms, calculated design flow is required. ** If No, a well permit must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for(5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of a 1 property lines and corners and making the site accessible so that a complete site evaluation can be performed. • Signature of Owner or Agent Date "J Printed Name of Owner or Agent V /L'' Ar fin- _ • • Catawba County Environmental Health (,,,,.. ,,,-- °' �,,..../.."-------1. c �, rtawt, arer ms K .F!. r ra rttr--y Ku 10 .044,3,,, ( .!5 .ks -----:::,..) --) rilligi Op logo iiiik . aiipKIP 10 f W� y r Itim‘i at Y A0 n p ` 0..„--_ts hiL ' IMO 7 0 lis, f it r arcs ' ri i L''' 4" 3 r1, S srp+3 •. f r ,0. ,gd 14 t dd. dAtiii:/f_ Parcel: 376207794221 , CLAREMONT, 28610 1 in=150ft This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 04/05/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 376207794221 Owner: This parcel is currently being processed Parcel Address: Owner2: null City: CLAREMONT, 28610 Address: null LRK(REID): 404623 Address2: null Deed Book/Page: City: null Subdivision: State/Zip: null null Lots/Block: / School Information: Last Sale: Plat Book/Page: School District: COUNTY Elementary School: CLAREMONT Legal: null Middle School: RIVER BEND Calculated Acreage: 10.000 High School: BUNKER HILL Tax Map: null Township: null State Road #: Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: CLAREMONT County Fire District: All in City Zoning]: R-2 Building(s) Value: $0 Zoning2: Land Value: $0 Zoning3: Assessed Total Value: $0 Zoning Overlay: Year Built/Remodeled: null/null Small Area: null Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: null Building Permits for this parcel. Firm Panel #: null Building Details 2010 Census Block: 3018 WaterShed: WS-IV Protected Area 2010 Census Tract: 010102 Voter Precinct: P6 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map(report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and that not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. New Pic leir(53 : 7-2 030 % fr YoD i-till , 1 2Cd, 2-gdpro 3(u) 9) /day. woml 0: 1 &wn-J- ' ` ohtt :/1 is.catawbacount nc. ov nl a / arcel_re ort. h P?ke Y-376207794221&t>P— P 4/5/2016 . . . . a310 � ( r- t =1 Sy' S ` Y "; ONi,: 9 a tty, � i 4.v,, s' 9 r. ' 14t,----..„% m 9l. ' 'F -r�{1� r -k, _ „ , �'' ,, a ._o' �`, y , a Perm'rt`Vumhe� Gl:ilx,� j(} ,* tgil: at ' . '- II CITY;OF CLAREMONT f .. ; , tIS ' .y 46 t' -: t f r t 'LONING1COAtPL1ANCECI RTIFICATe. t, 's f s i L.� -!, Applicant � h -ti— l t1j it45` PIbKL t✓+�, .Phone �t +`tf W2 tzz� :1 rye j Address: J�t f" l4%it 1Y'1Nl ?fit,�r r .4 '4, �y Os ncr ice' a ..Phone ;t.. e n '. l ,. � t i '� r aa ., �. .-r rtz t �r. . ' Location I i-Yl 'n4141"4--;?-' ' ;:; r "§{( ' , . 77 L cZ1? ;t 4C-91%.°1:411.11} - J ir.rel.re P,oposei: "' ' �if1.tIe GJw+rlt 1<riic,i� a ' '•,.0-- v,,,ze � iVj � s • A s¢e plan knowingdproperty size,all ettst,ng structures proposed strurcttnes and dulances i tr ,`3•r - R r from property and right(s)-of-way;lines is required and r op.sidered a part,of this pen-nh t' , r."'�• 'I bispenmi will;expire six(6)month's from the date 0 t- issued ifwork`has not begun on 4i' ' the apj7roved t�tis•itY. , e. ` i e `1 '` -, ' • Thin permit"ill expire n ssork is suspend d or�.abandoned fora period oR ore Veai _ ;7.10-,; ' Thu permn milt'be revo.ed if the n oin881i.es any false�infot c• :::. t z " r , 3• , , �dri1�'. Alt A. -.o: 17 _ .k"J� v`d((n 34 4 ., 'A;;""?.: -i t'. r\pp,cant s Signs.4e ,'> s '' "Bate .1 ` c ,,,,., �s,, a ' .-- } OFFICE USEONL1 b fi� �, ' l �-�7"' lanmg District -°' Inside Gu-,Limns: C,ensue I iact 'V .��G f �+ s l Y 2 ' ,11::;:e" P Ii `- ' 5 � x � I dM1 ` rRequired Setba ks Front _ gSidc = !! Flood ZoncS 4 3 tit � n t i , � rt} r t ` Ream L StreetSide - rBFI �� w : -:r r COMMENTS: . . ` ; 't e s T } t , ',�i a . • ;:.,. Zoning.Admunstrator s Signature „s ate .." ` s Cop,es of this parmn for C atewbn Cou�b Beilding Inspa,ions 3,d the agphcant/o ne i personal reoords am 1 atonable upon reques , .,. 828-4a9-7009 City Hall•828-'45P-95g:96 Fay - r"S` r `� .3288 Gist Main Street•Po`ct Office Box 446 Clremont,'NC 28610 l ''' �� a ,i